Sunday PM preops

[GameSeven]

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How do most residency programs do there preops? Especially for Monday cases that don't get posted on Friday.

I have heard that in many programs the residents who will be doing the case end up coming in Sunday afternoon/evening to do preops, even when they have the weekend "off". (I know for sure in the program at my med-school this is the case.)

How big a deal is this? Are there programs where the weekend preops are done by the call team there for the weekend anyway?

Seems like most people around here find this one of the more annoying parts of their residency training.

 

[deleted126335]

How do most residency programs do there preops? Especially for Monday cases that don't get posted on Friday.

I have heard that in many programs the residents who will be doing the case end up coming in Sunday afternoon/evening to do preops, even when they have the weekend "off". (I know for sure in the program at my med-school this is the case.)

How big a deal is this? Are there programs where the weekend preops are done by the call team there for the weekend anyway?

Seems like most people around here find this one of the more annoying parts of their residency training.

It was true for my residency twenty years ago. Hated it. Stupid waste of time. But it was expected. Probably the thing that I most resented during residency.

 

[seinfeld]

It was true for my residency twenty years ago. Hated it. Stupid waste of time. But it was expected. Probably the thing that I most resented during residency.

Completely agree with it being a massive waste of time and a large part of the disgust with academics. A huge part of being an anesthesiologist is to be able to assess a patient and come up with a plan quickly; add-ons, emergencies and intraoperative changes of plan happen all the time. Better time management and education would come from reading about the intraoperative management of the specific surgery than worrying about patient details the night before.

Besides it used to annoy me when i would spend an hour doing my workups only to come in and find out my list completely changed.

 

[B-Bone]

At my program, we never pre-opped anybody the night before. The schedule was huge (with 75 operating rooms and ~160 cases/day) the schedule was never finalized until about 9 pm, so you couldn't be sure what was in your room. Combine this with the fact that almost all of the patients are admitted the morning of surgery, and the system really doesn't allow for night-before preops. I just showed up every day at about 6 am (or 530 for cardiac), looked up my first patient. Usually just the first, because the schedule changed so much, that you rarely did your case list in its entirety and often had emergencies added or cases moved from other rooms. I had to make a plan and commit to it, because I would usually just see my attending maybe 5 minutes before the patient was brought back. This was a great thing,because it made you think on your feet and commit to something. Your attending might switch things up on you completely at the last minute, but again this taught you to be flexible and roll with whatever was thrown at you. There might be the odd extremely rare condition or case that curveballed you at 6 am, but you just grabbed a book or busted out PubMed and figured it out on the fly. I think you get shortchanged on these useful skills if you have some 10 pm phone convo with your attending the night before and just do whatever they want. I don't really see the value in night-before preops.

One caveat to this approach is that all of our patients had been seen by an internist or gone through the PreOp Evaluation clinic (run by anesthesia) and had killer workups. Also we had an incredible electronic medical record and info was readily available.

 

[Bertelman]

How do most residency programs do there preops? Especially for Monday cases that don't get posted on Friday.

I have heard that in many programs the residents who will be doing the case end up coming in Sunday afternoon/evening to do preops, even when they have the weekend "off". (I know for sure in the program at my med-school this is the case.)

How big a deal is this? Are there programs where the weekend preops are done by the call team there for the weekend anyway?

Seems like most people around here find this one of the more annoying parts of their residency training.

I think we would revolt if they made us come in and do pre-ops ino the weekend.

During the week, all available residents contribute to pre-ops. Doesn't matter whose case it is, but if you know which room you have, you would rather do your own. On Sundays, the call team does them for monday a.m.

I see no good argument for making someone come in on the weekends and pre-op their own patient. I could make an argument that there is equal value in being able to pre-op your colleague's patients, then communicate any medical issues in a succinct manner for all to use.

 

[BobBarker]

In PP, I guess they just have someone in holding pre-op the patient the day of the surgery?

 

[periopdoc]

In residency, general OR cases posted on Friday were seen by whichever residents finished their rooms first. Cases that were posted on Saturday and Sunday were theoretically seen by the call team. If I was on call I would usually only preop the add ons that were first case of the day as there is no reason that the attending and resident assigned to the room could not sort out second and third cases etc. If the first case was a 15-20 min variety, I would go ahead and preop the second case. I never did preops on CRNA cases and I do not recall any pressure to do them.

Cardiac cases were the responsibility of the cardiac team. These folks were thoroughly worked up by the surgical team and could be evaluated online. I would read through their notes online and fill out all of the preop form except the exam portion which I would leave to the operative team. The EMR at UW is pretty handy.

In PP, I do all of my preops in the preop area. If there is a particularly difficult case coming up, the surgeons will give me a heads up and we will discuss any needed workup.


- pod

 

[cchoukal]

Where I trained (U of Chicago), we had to come in for in-patient pre-ops for the first 6 mos of CA1 year. This happened maybe once per month, at most. After 6 months, the call team would see the patient and call us.

 

[periopdoc]

Where I trained (U of Chicago), we had to come in for in-patient pre-ops for the first 6 mos of CA1 year. This happened maybe once per month, at most. After 6 months, the call team would see the patient and call us.

I forgot about the first six months. Same deal at UW.

-pod

 

[lord_jeebus]

Where I trained (U of Chicago), we had to come in for in-patient pre-ops for the first 6 mos of CA1 year. This happened maybe once per month, at most. After 6 months, the call team would see the patient and call us.

This is how we do it also, except that I came in 2-3 times/mo as a CA-1.

 

[Code Brown]

Our program has the weekend call team see them if the schedule isn't out by the time we leave on Friday (otherwise we see them Friday and re-sign everything Monday morning). Either the Sat or Sun call team can see them if it's after that. In all honesty, seeing the patient the day before is really low yield if you can look up most of their info online from home and place the basic NPO, IVF, start IV, etc orders online or by calling in to the nursing station. Also, most surgery teams (who will have rounded on Sunday) will fix any really obvious deficiencies, and the minor things can usually be addressed in the morning. If it's anything major, there is probably nothing you can do about it the night before anyway (even echo's take time to order, scan, and interpret). If cancelling the case is on the table, the attending will be the one to do that and they sure as hell are not coming in the day before.

If a program makes you come in on your day off, worry about other "low yield" busy work they may shackle you with for the next 3-4 years when it comes to making a decision as to where you rank them.

 

[sweetalkr]

Don't forget, especially in the political spectrum we are entering, that you are a consultant. A surgeon is asking you essentially "is this patient ready to be safely anesthetized for surgery? if not, what should we do so the surgery I would like to perform Monday can be performed in a timely fashion?"

yes sometimes you need to delay, but remember in the real world they have to have patients to cut on or both of you don't get paid. also, the more you get out of work or not get things done, the worse you, your colleagues, your department, and your specialty look bad. and the more enticing a mindless nurse that will ok the surgery and do it on time becomes to the surgeon